Gestational diabetes mellitus diagnosed with a 2-h 75-g gras glucose tolerance test and adverse pregnancy outcomes

OBJECTIVE - To evaluate American Diabetes Association (ADA) and World Healt h Organization (WHO) diagnostic criteria for gestational diabetes mellitus (GDM) against pregnancy outcomes. RESEARCH DESIGN AND METHODS - This cohort study consecutively enrolled Braz ilian adult women attending general prenatal clinics. All women were reques ted to under take a standardized 2-h 75-g oral glucose tolerance test (OGTT ) between their estimated 24th and 28th gestational weeks and were then fol lowed to delivery. New ADA criteria for GDM require two plasma glucose valu es greater than or equal to5.3 mmol/l (fasting), greater than or equal to 1 0 mmol/l(l h), and greater than or equal to8.6 mmol/l (2 h). WHO criteria r equire a plasma glucose greater than or equal to7.0 mmol/l (fasting) or gre ater than or equal to7.8 mmol/l (2 h). Individuals with hyperglycemia indic ative of diabetes outside of pregnancy were excluded. RESULTS - Among the 4,977 women studied, 2.4% (95% CI 2.0-2.9) presented wi th GDM by ADA criteria and 7.2% (6.5-7.9) by WHO criteria. After adjustment for the effects of age, obesity, and other risk factors, GDM by ADA criter ia predicted an increased risk of macrosomia (RR 1.29, 95% CI 0.73-2.18), p reeclampsia (2.28, 1.22-4.16), and perinatal death (3.10, 1.42-6.47). Simil arly, GDM by WHO criteria predicted increased risk for macrosomia (1.45, 1. 06-1.95), preeclampsia (1.94, 1.22-3.03), and perinatal death (1.59, 0.86-2 .90). Of women positive by WHO criteria, 260 (73%) were negative by ADA cri teria. Conversely, 22 (18%) women positive by ADA criteria were negative by WHO criteria. CONCLUSIONS - GDM based on a 2-h 75-g OGTT defined by either WHO or ADA cri teria predicts adverse pregnancy outcomes.